EMR Integration After Acquisitions: A Guide for MSOs

With 600 EMR systems available today, management services organizations in acquisition mode face integrating dozens of different platforms. Focused on streamlining operations and cutting costs during rapid expansion, MSOs must insist that every new practice shift to their EMR. 

Integrating acquisitions’ current EMRs can be one of the first big challenges post-acquisition. You’re marshaling contact info, technical details, and lexicons for each. Practice and physician group staff at each acquisition is tech-change weary; it’s an industry phenomenon. And then there’s data incompatibility, migration risks, and compliance concerns for each that arise when integrating smaller entities into a larger one. 

So, yes. The EMR integration will take months and several stakeholders at every acquisition. Expect some of your acquisitions to progress faster than others. However, several eventual advantages – for providers as well as the MSO – make integrating all new properties’ EMRs into yours vital. 

First, the MSO will likely bring a more powerful EMR to each acquired practice or group. The most comprehensive EMR systems go beyond the basic features and support more complex clinical, administrative, and financial needs. Other advantages include telehealth integration, population health management, AI and machine learning capabilities to support decisions, workflows, reporting and analytics, remote access, and more. In today’s healthcare industry, modernization using as much analytics and automation as possible is critical to an organization’s success. Even better, these tools' power to improve patient care, enhance operational efficiency, and support financial health is documented. Your providers will appreciate the opportunity to use advanced, modern systems. 

Further, with a portfolio of acquisitions, the MSO will have already encountered and rectified issues with the EMR.

Finally, having many practices on one system gives the MSO more negotiating and customer service power. When an MSO complains, the EMR company most likely jumps to appease them. Again, providers should appreciate that you’re lifting this burden from them. 

Those integrating multiple EMRs succeed when they understand the strategic steps they can take before, during, and after the acquisition. Pulling in support from EMR customer service, setting up a technology lead on your integration team, and more tactics will control the chaos that can accompany rapid expansion. Use this guidance to map your steps. 

Evaluate the EMR integration landscape before the acquisition

Due diligence 

Technical details

As our post on medical practice-acquisition due diligence points out, scrutinizing your target’s  IT and software systems in the evaluation phase is critical. Some healthcare leaders believe you should prioritize technology compatibility (and even engage the entity’s IT early on) in the merger and acquisition process. 

Put your technology specialists on documentation of data management protocols, cybersecurity defenses, technological discrepancies, compatibility concerns, or any other hurdles that might complicate your integration phase. Have them assess and outline a strategic plan for integration so you can gauge the effort and resources required to absorb the organization. 

Acquisition staff buy-in

Possibly more important, during due diligence, evaluate the target’s willingness to switch to your EMR. Emphasize that using it is non-negotiable and that they will need to deliver this news to staff. 

Language alignment

Also during due diligence, it’s critical to evaluate the target EMR’s medical terminologies. How cumbersome will it be to translate those terms into the ones your EMR uses.

For example, EMR A’s "Annual Checkup,” is the same service as EMR B’s, "Routine Physical Exam.” In another example, "Appendix Removal Surgery" in EMR System A and "Appendectomy" in EMR System B refer to the same surgical procedure. Straightening out this language takes work. Terms must change from those listed in the acquisition’s dictionary to those the MSO uses to avoid errors and missed payments. The first step will be mapping their terms to their analogs in your system. 

Even if terms don’t match, the mapping process can shift the language. Should you have them, know that you can always use data transformation tools to automate the mapping process and ensure accuracy.

Update the EMR systems to use the standardized term, ensuring consistency across all records and reducing the risk of misinterpretation. Again, it’s the practice or physician group’s responsibility to convey these changes to staff. 

Monitoring EMR integration after acquisition

As meticulous as you tried to be during due diligence, “no plan survives first contact with the enemy.” While neither the EMRs nor entities are enemies, the point is that you don’t know what you’re getting into until you’re in it. Particularly when you’re adding multiple locations at once, you will face unexpected challenges. 

The most crucial step in integrating EMRs is to bring your EMR’s customer service on board. The increased revenue they will gain from the additional work demands their involvement. Review this list of what you can expect from your EMR support team to make sure you’re getting the most from them. 

No matter how many acquisitions you are rolling up, they are responsible for:

Assessment and planning - The EMR customer service team should conduct a thorough assessment of the existing and new EMR systems to understand the specific requirements and potential challenges. With this information, they should develop an integration plan tailored to the MSO's needs, including timelines, milestones, and resource allocation.

Customization and configuration - The EMR reps should assist in customizing the EMR system to integrate the MSO and the newly acquired entity. This step may include ensuring the systems’ compatibility and performance. 

Data migration and management - First, the EMR company should spearhead the mapping of data fields between the existing and new EMR systems. They are also responsible for overseeing the data migration process. Risks at this juncture include data loss, duplication, or corruption.

Initial staff training and ongoing support: The EMR company is the best source to provide training and support for their product. It should also provide continuous support and troubleshooting during and after integration. 

 Interoperability and compliance - Your EMR reps should let you know of all interoperability solutions including HL7, FHIR, X12, Open APIs, and more. They should be able to reassure you that all integrations comply with HIPAA and any other state and federal regulations. 

Monitoring and optimization - The EMR company should be constantly monitoring its system for performance. Look to it to provide recommendations for optimization and improvements. 

Signs of EMR interoperability issues to watch out for on your end

EMR customer service has a lot on their plate with your multiple roll-ups. When an MSO is integrating the EMR of a new acquisition with its own EMR, several signs can indicate interoperability issues. Identifying these early helps you address them promptly. 

Watch for these 10 issues: 

1. Data inconsistencies - mismatched patient demographics, duplicate entries, or incomplete data can lead to errors in patient care and administrative processes. These misses indicate that data from different systems are not aligning properly.

2. Communication failures - when errors or incomplete messages arise, you may have a problem with the interoperability standards or protocols used by the different EMR systems.

3. Slow data retrieval and processing - delays in retrieving or processing data from the integrated EMR systems could be signs of inefficient data exchange mechanisms or incompatibilities in the system architecture.

4. Inconsistent terminologies and coding - Differences in medical terminologies, coding systems, and classifications can lead to misinterpretation of clinical data and hinder effective communication between systems.

5. Frequent system downtime or crashes -  Regular system outages, crashes, or errors when accessing or integrating EMR data indicate underlying technical issues and incompatibilities between the EMR systems.

6. Unsuccessful data mappings - inaccurate or incomplete mapping of data fields between the two EMR systems can cause patient data loss.

7. Poor user experience and feedback -  negative feedback from healthcare providers and administrative staff regarding the usability and performance of the integrated EMR system reveals interoperability issues.

8. Compliance and security issues - regulatory requirement misses reveal that the integrated system may not be adequately protecting patient data or maintaining compliance with even more legal standards.

9. Incomplete data integration - data elements or records not integrated into the new system can compromise patient care continuity and the accuracy of medical records.

10. Compatibility errors with third-party applications -  issues integrating with third-party applications, such as lab systems, radiology systems, or billing software suggest that the EMR systems are not fully compatible with other essential healthcare technologies. Full compatibility underlies comprehensive patient care and operational efficiency.

By closely monitoring these signs, MSOs can proactively identify and address interoperability issues, ensuring a more effective and seamless integration of EMR systems.

Who’s leading the EMR integration?

As described in our medical practice integration post, when integrating a new acquisition, MSOs face the melding of many complex business areas other than EMR.

The MSO will also lead the integration of these departments and workflows:

• Legal
• Finance
• HR
• Culture
• Clinical operations 
• Administration operations
• Communication
• Sales and Marketing
• Value Creation

It’s a great deal of work, and one that most merger and acquisitions consultants explain will take up to a year. 

You may think a business manager and other in-house professionals can execute all of these areas to completion. Experienced MSOs, however, select an integration manager or even establish an integration management office (IMO), complete with an experienced IMO manager. Other professionals in your IMO could be an industry specialist, an attorney, and various team leads (finance, legal, sales, technology, operations, marketing). 

To streamline the EMR integration process, MSOs should appoint a technology lead in the IMO. Should you not have this individual, it may be possible to find an outside IT advisor who understands the opportunities and pitfalls of post-acquisition integration. Find one whose expertise goes beyond general IT and into the realm of merger and acquisition complexities. 

Apprise your EMR integration manager of:

• the reasons the target was selected
• the goals of the merger
• the business plan and the integration plan
• guiding principles that will steer decision-making throughout the integration process.
• any cultural differences between the two entities
• all communications going to the acquisition regarding the EMR
• the budget for EMR integration including tech infrastructure changes

Monitoring EMR performance after EMR integration 

After integrating EMR systems following an acquisition, it is crucial for MSOs to continuously monitor the performance of the integrated system to ensure its efficiency and reliability. Take these steps to monitor EMR performance:

 1. Establish key performance indicators (KPIs) including:

•  system uptime 
•  response time:  transaction and patient record load time
•  error rates
•  user satisfaction
•  data accuracy

 2. Implement real-time monitoring tools to track its performance. System monitoring software options include SolarWinds, Datadog, and Splunk. Consider creating a centralized dashboard to display real-time performance data and alerts.

 3. Conduct regular audits and assessments to ensure ongoing compliance and identify potential issues. Consider periodic audits for data integrity and security compliance. Use assessment reports to gather performance metrics. 

 4. Collect and analyze user feedback to understand user experience and identify areas for improvement. You can use surveys, questionnaires, and even focus groups to gather feedback. 

 5. Perform routine data quality checks to maintain high standards of data integrity and accuracy. Validate that data entries meet predefined standards. Implement procedures for promptly correcting identified data errors

 6. Review interoperability and integration performance to check seamless data exchange with other systems and stakeholders. Monitor the performance of interfaces with other systems (e.g., lab systems, billing software). Conduct regular interoperability tests to ensure data exchange protocols (e.g., HL7, FHIR) are functioning correctly.

 7. Check that ongoing training supports user proficiency and system utilization. Keep user manuals, access to help desks, and online resources handy. 

 8. Monitor security and compliance to protect patient data and adhere to regulatory requirements. Conduct regular security audits to identify vulnerabilities and ensure compliance with regulations like HIPAA. Implement and regularly update incident response plans to handle data breaches or security threats.

 9. Schedule regular review meetings to discuss system performance and address emerging issues. Include IT staff, healthcare providers, administrative personnel, and management. Agenda: 

• analyze recent performance metrics and identify trends.
• issues encountered and develop action plans to address them.
• future enhancements brainstorming

By following these steps, MSOs can effectively monitor the performance of their integrated EMR systems, ensuring they continue to meet the needs of their organization and deliver high-quality patient care.

Reinforce EMR performance with revenue-optimization software

Revenue cycle management (RCM) software supports and enhances EMR system performance by automating several key tasks and improving the quality of the data in the EMR. Automated eligibility verification cuts staff burden and manual errors. It integrates billing processes with the EMR, ensuring that services rendered are accurately billed. Via its analytics functions, it generates reports, so that providers understand revenue patterns, identify bottlenecks, and optimize workflows. 

All of these steps help healthcare organizations optimize their revenue. One important way of sweeping in the most revenue is via proactive contract management and modeling. With a staffing shortage and a lack of contract experience existing at most healthcare organizations these days, payer-proposed contract changes and even renewals go unanswered. When providers don’t participate in contract establishment and maintenance, payers get the rates and terms they want. 

Contract management and underpayments tool, RevFind, steps in to support the provider in contract optimization. This software processes, digitizes, and analyzes payer contracts. Comparing each payment against contract terms and alerting staff to any discrepancies ensures payers honor their contracts. Payer underpayments are widespread in the healthcare sphere. By addressing underpayments, organizations can increase recovered cash and improve profit margins. They can also compare payer contract performance, a step that provides the data to negotiate better contract terms and fees. 

‍Schedule a demo to see how you take control of your contracts and sweep in full revenue per your contract terms.

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